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Scattered Minds Chapter 9. Attunement and Attachment
Author: Gabor Mate Publisher: London, UK: Random House. Publish Date: 1999 Review Date: Status:💥
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The right hemisphere of the mother’s brain, the side where our unconscious emotions reside, programs the infant’s right hemisphere. In the early months, the most important communications between mother and infant are unconscious ones. Incapable of deciphering the meaning of words, the infant receives messages that are purely emotional. They are conveyed by the mother’s gaze, her tone of voice and her body language, all of which reflect her unconscious internal emotional environment. Anything that threatens the mother’s emotional security may disrupt the developing electrical wiring and chemical supplies of the infant brain’s emotion-regulating and attention-allocating systems.*
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By two to seven weeks, the infant will orient toward the mother’s face in preference to a stranger’s—and also in preference to the father’s, unless the father is the mothering adult. At seventeen weeks, the infant’s gaze follows the mother’s eyes more closely than her mouth movements, thus fixating on what has been called “the visible portion of the mother’s central nervous system.” The infant’s right brain reads the mother’s right brain during intense eye-to-eye mutual gaze interactions. As an article in Scientific American expressed it, “Embryologically and anatomically the eye is an extension of the brain; it is almost as if a portion of the brain were in plain sight.”1 The eyes communicate eloquently the mother’s unconscious emotional states:
[O]ne person uses another’s pupil size as a source of information about that person’s feelings or attitudes; this process usually occurs at unconscious levels. Dilated pupils occur in states of pleasure and are an indicator of “interest” … Experiments have shown that women’s eyes dilate in response to a picture of a baby. Most importantly … viewing enlarged dilated pupils elicits larger pupils in the observer. In a developmental study, infants smiled more when a female experimenter’s eyes were dilated rather than constricted …
Everyone has had the experience of suddenly feeling intense physiological and psychological shifts internally at trading glances with another person; such shifts can be exquisitely pleasurable or unpleasant. How one person gazes at another can alter the other’s electrical brain patterns, as registered by EEGS, and may also cause physiological changes in the body. The newborn is highly susceptible to such influences, with a direct effect on the maturation of brain structures.
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Maternal depression is associated with diminished infant attention spans. Summarizing a number of British studies, Dale F. Hay, a researcher at the University of Cambridge, suggests “that the experience of the mother’s depression in the first months of life may disrupt naturally occurring social processes that entrain and regulate the infant’s developing capacities for attention.”3
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Just how important a close moment-to-moment connection between mother and infant can be was illustrated by a cleverly designed study, known as the “double TV experiment,” in which infants and mothers interacted via a closed-circuit television system. In separate rooms, infant and mother observed each other and, on “live feed,” communicated by means of the universal infant-mother language: gestures, sounds, smiles, facial expressions. The infants were happy during this phase of the experiment. “When the infants were unknowingly replayed the ‘happy responses’ from the mother recorded from the prior minute,” writes the UCLA child psychiatrist Daniel J. Siegel, “they still became as profoundly distressed as infants do in the classic ‘flat face’ experiments in which mothers-in-person gave no facial emotional response to their infant’s bid for attunement.”4
Why were the infants distressed despite the sight of their mothers’ happy and friendly faces? Because happy and friendly are not enough. What they needed were signals that the mother is aligned with, responsive to and participating in their mental states from moment to moment. All that was lacking in the instant video replay, during which infants saw their mother’s face unresponsive to the messages they, the infants, were sending out.
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This sharing of emotional spaces is called attunement.5 Emotional stress on the mother interferes with infant brain development because it tends to interfere with the attunement contact.
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Attunement is necessary for the normal development of the brain pathways and neurochemical apparatus of attention and emotional self-regulation. It is a finely calibrated process requiring that the parent remain herself in a relatively nonstressed, non-anxious, nondepressed state of mind. Its clearest expression is the rapturous mutual gaze infant and mother direct at each other, locked in a private and special emotional realm, from which, at that moment, the rest of the world is as completely excluded as from the womb.
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Attunement does not mean mechanically imitating the infant. It cannot be simulated, even with the best of goodwill. As we all know, there are differences between a real smile and a staged smile. The muscles of smiling are exactly the same in each case, but the signals that set the smile muscles to work do not come from the same centers in the brain. As a consequence, those muscles respond differently to the signals, depending on their origin. This is why only very good actors can mimic a genuine, heartfelt smile. The attunement process is far too subtle to be maintained by a simple act of will on the part of the parent. Infants, particularly sensitive infants, intuit the difference between a parent’s real psychological states and her attempts to soothe and protect the infant by means of feigned emotional expressions. A loving parent who is feeling depressed or anxious may try to hide that fact from the infant, but the effort is futile. In fact, it is much easier to fool an adult with forced emotion than a baby. The emotional sensory radar of the infant has not yet been scrambled. It reads feelings clearly. They cannot be hidden from the infant behind a screen of words, or camouflaged by well-meant but forced gestures. It is unfortunate but true that we grow far more stupid than that by the time we reach adulthood.
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In attunement, it is the infant who leads and the mother who follows. “Where their roles differ is in the timing of their responses,” writes John Bowlby, one of the century’s great psychiatric researchers.6 The infant initiates the interaction or withdraws from it according to his own rhythms, Bowlby found, while the “mother regulates her behaviour so that it meshes with his … Thus she lets him call the tune and by a skillful interweaving of her own responses with his creates a dialogue.”
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The tense or depressed mothering adult will not be able to accompany the infant into relaxed, happy spaces. He may also not fully pick up signs of the infant’s emotional distress, or may not be able to respond to them as effectively as he would wish. The ADD child’s difficulty reading social cues likely originates from her relationship cues not being read by the nurturing adult, who was distracted by stress.
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In the attunement interaction, not only does the mother follow the child, but she also permits the child to temporarily interrupt contact. When the interaction reaches a certain stage of intensity for the infant, he will look away to avoid an uncomfortably high level of arousal. Another interaction will then begin. A mother who is anxious may react with alarm when the infant breaks off contact, may try to stimulate him, to draw him back into the interaction. Then the infant’s nervous system is not allowed to “cool down,” and the attunement relationship is hampered.
Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense—rightly or wrongly—that no one can share how they feel, that no one can “understand.”
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Attunement is the quintessential component of a larger process, called attachment.7 Attachment is simply our need to be close to somebody. It represents the absolute need of the utterly and helplessly vulnerable human infant for secure closeness with at least one nourishing, protective and constantly available parenting figure. Essential for survival, the drive for attachment is part of the very nature of warm-blooded animals in infancy, especially of mammals.
In human beings, attachment is a driving force of behavior for longer than in any other animal. For most of us it is present throughout our lives, although we may transfer our attachment need from one person—our parent—to another—say, a spouse or even a child. We may also attempt to satisfy the lack of the human contact we crave by various other means, such as addictions, for example, or perhaps fanatical religiosity or the virtual reality of the Internet. Much of popular culture, from novels to movies to rock or country music, expresses nothing but the joys or the sorrows flowing from satisfactions or disappointments in our attachment relationships. Most parents extend to their children some mixture of loving and hurtful behavior, of wise parenting and unskillful, clumsy parenting. The proportions vary from family to family, from parent to parent. Those ADD children whose needs for warm parental contact are most frustrated grow up to be adults with the most severe cases of ADD.
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Already at only a few months of age, an infant will register by facial expression his dejection at the mother’s unconscious emotional withdrawal, despite the mother’s continued physical presence. “(The infant) takes delight in Mommy’s attention,” writes Stanley Greenspan, “and knows when that source of delight is missing. If Mom becomes preoccupied or distracted while playing with the baby, sadness or dismay settles in on the little face.”8
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Even though fully half of the roughly hundred thousand genes in the human organism are dedicated to the central nervous system, the genetic code simply cannot carry enough information to predetermine the infinite number of potential brain circuits. For this reason alone, biological heredity could not by itself account for the densely intertwined psychology and neurophysiology of attention deficit disorder.
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Experience in the world determines the fine wiring of the brain. As the neurologist and neuroscientist Antonio Damasio puts it, “Much of each brain’s circuitry, at any given moment in adult life, is individual and unique, truly reflective of that particular organism’s history and circumstances.”2 This is no less true of children and infants. Not even in the brains of genetically identical twins will the same patterns be found in the shape of nerve cells or the numbers and configuration of their synapses with other neurons.
The microcircuitry of the brain is formatted by influences during the first few years of life, a period when the human brain undergoes astonishingly rapid growth. Five-sixths of the branching of nerve cells in the brain occurs after birth. At times in the first year of life, new synapses are being established at a rate of three billion a second. In large part, each infant’s individual experiences in the early years determine which brain structures will develop and how well, and which nerve centers will be connected with which other nerve centers, and establish the networks controlling behavior.3 The intricately programmed interactions between heredity and environment that make for the development of the human brain are determined by a “fantastic, almost surrealistically complex choreography,” in the apt phrase of Dr. J. S. Grotstein of the department of psychiatry at UCLA. Attention deficit disorder results from the miswiring of brain circuits, in susceptible infants, during this crucial period of growth.
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One way to see this is as a compromise negotiated by nature. We were permitted to walk, freeing our forelimbs to evolve into arms and hands capable of many delicate and complicated activities—a development that gave impetus to a large expansion in brain size, particularly of the frontal lobes. These lobes coordinate the movements of the hands. They also perform the problem solving and the social and language skills that have given humankind abilities to thrive in a wide variety of habitats. Were we born with our wiring rigidly fixed by heredity, the frontal lobes would be far more limited in their capacity to learn and to adapt to the many different possible environments that human beings inhabit.
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According to the latest insights of modern neuroscience, brain development in the human infant involves a process of competition that has been described as “neural Darwinism.”4 Nerve cells, circuits, networks and systems of networks vie with one another for survival. The neurons and connections most useful to the organism’s survival in its given environment are maintained. Others wither and die. Nerve pathways lacking the full conditions for growth will not develop, or will develop dysfunctionally and incompletely. The stores of neurochemicals that are underutilized diminish, and the brain’s capacity to manufacture them declines. By the elimination of unused cells and synapses, and by the formation of new ones favored by the environment, specialized circuits gradually develop that conduct the varied and multiple activities of the human brain.
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Neural Darwinism means that our genetic potential for brain development can find its full expression only if circumstances are favorable. To understand this, we need only imagine an infant kept in a dark room, held, physically cared for and fed, but never spoken to. After a year of such deprivation, the brain of this infant would not be comparable to those of other infants, no matter what her inherited potential. Despite perfectly good eyes at birth and healthy nerves to conduct visual images to the brain, the thirty or so neurological units that together make up visual sense would not develop. Even the neurological components of vision present at birth would atrophy and become useless if this child never saw light for about five years. Irreversible blindness would be the result. If we surrounded the child with silence for the first ten years, he would never be able to learn human speech. Attention deficit disorder is also an example of how the neural circuitry and biochemistry of the brain may be held back from developing optimally when appropriate input from the environment is interfered with. What, then, are the optimal conditions for full brain development?
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In the womb environment, no action or reaction on the developing infant’s part is required for the provision of any of his needs. Life in the womb is surely the prototype of life in the Garden of Eden where nothing can possibly be lacking, nothing has to be worked for. If there is no consciousness—we have not yet eaten of the Tree of Knowledge—there is also no deprivation or anxiety.
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Except in conditions of extreme poverty unusual in the industrialized world, although not unknown, the nutritional needs and shelter requirements of infants are more or less satisfied. The third prime requirement, a secure, safe and not overly stressed emotional atmosphere, is the one most likely to be disrupted in Western societies.
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The human infant lacks the capacity to follow or cling to the parent soon after being born, and is neurologically and biochemically underdeveloped in many other ways. The first nine months or so of extrauterine life seem to have been intended by nature as the second part of gestation. The anthropologist Ashley Montagu has called this phase exterogestation, gestation outside the maternal body.5 During this period, the security of the womb must be provided by the parenting environment. To allow for the maturation of the brain and nervous system that in other species occurs in the uterus, the attachment that was until birth directly physical now needs to be continued on both physical and emotional levels. Physically and psychologically, the parenting environment must contain and hold the infant as securely as she was held in the womb.
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For the second nine months of gestation, nature does provide a near-substitute for the direct umbilical connection: breast-feeding. Apart from its irreplaceable nutritional value and the immune protection it gives the infant, breast-feeding serves as a transitional stage from unbroken physical attachment to complete separation from the mother’s body. Now outside the matrix of the womb, the infant is nevertheless held close to the warmth of the maternal body from which nourishment continues to flow. Breast-feeding also deepens the mother’s feeling of connectedness to the baby, enhancing the emotionally symbiotic bonding relationship. No doubt the decline of breast-feeding, particularly accelerated in North America, has contributed to the emotional insecurities so prevalent in industrialized countries.
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Even more than breast-feeding, healthy brain development requires emotional security and warmth in the infant’s environment. This security is more than the love and best possible intentions of the parents. It depends also on a less controllable variable: their freedom from stresses that can undermine their psychological equilibrium. A calm and consistent emotional milieu throughout infancy is an essential requirement for the wiring of the neurophysiological circuits of self-regulation. When interfered with, as it often is in our society, brain development is adversely affected. ADD is one of the possible consequences.